Sarah Murnaghan's lung transplant surgery successful

Sarah Murnaghan, the 10-year-old girl suffering from end-stage cystic fibrosis whose bid to get a transplant from adult lungs drew national attention, received a lung transplant Wednesday.

"Her doctors are very pleased with both her progress during the procedure and her prognosis for recovery,'' her family said in a statement issued after surgery in Philadelphia.

The family said the six hour surgery went well, and that doctors used a lung from an adult donor, cut down to fit the child's body.

"The surgeons had no challenges resizing and transplanting the donor lungs,'' the Murnaghan family said. "The surgery went smoothly and Sarah did extremely well. ''

They said she was moved to intensive care after the surgery and faces a long recovery.

Maureen Garrity, a spokeswoman for the family, says the lungs are from an adult.

Garrity says the family is "beyond excited" but mindful that someone else "had to lose a family member."

Sarah captured the public's attention in recent weeks after her parents pleaded that she be put on the waiting list for adult lungs. Her family and the family of an 11-year-old boy, also awaiting a lung transplant at Children's Hospital of Philadelphia, challenged transplant rules that make children under 12 wait for pediatric lungs; they can be offered adult lungs only after adolescents and adults on the waiting list have been considered. Last week, a judge ordered the Organ Procurement and Transplantation Network to add her to the list for adult lungs. The judge's ruling covered both children.

Ashish Shah, the surgical director of lung transplants at The Johns Hopkins Hospital in Baltimore, says the surgery "is a difficult operation that lasts from four to 10 hours, depending on the patient, previous scar tissue and how the lungs perform after the implant."

If all goes well, patients usually spend one to two days in intensive care and another two weeks in the hospital, he says. But "some patients can spend months in the hospital recovering if there are complications."

A lot of physical therapy and rehabilitation are necessary after the transplant, Shah says.

He says overall the chance of death within 30 days of lung transplant is as low as 5% in most experienced centers. The one-year survival rate is 80% to 90% depending on the center and the complexity of the patients being operated on, Shah says.

About half of patients live to about five years after surgery, and a third make it for 10 years, he says.

Art Caplan, head of the division of medical ethics at New York University Langone Medical Center, told USA TODAY, "Adult lungs don't fit well in children's bodies, and that makes it hard to transplant them.
You are looking at using a piece of lung instead of a whole lung, and that makes it makes it a more difficult procedure and less likely to work.

"Lung transplants are a difficult operation, and they do fail," he says.

"It doesn't work all that well compared to other kinds of transplants. That's partly because when you transplant lungs, you have to give immunosuppressive medication so that they don't reject the lung. That opens up the lungs to infection. The lungs are constantly exposed to viruses and bacteria, so infection is a huge problem with lung transplants," Caplan says.

Joshua Sonett, chief of General Thoracic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, says Sarah's recovery may be challenging. "The sicker you are going into it, the harder it's going to be to recover. And she was extremely sick going into it."

No one would have heard about this story if there were enough organ donors in this country, he says. "We have to improve organ donation."

The better system -- which some other countries use -- is that everyone is presumed to be an organ donor, and people would have to "opt out" not to be one, he says. If that was the case, there would be plenty of organs, he says.